急诊科床旁超声诊断残端阑尾炎
Point-of-care ultrasound diagnosis of stump appendicitis in the emergency department.
作者信息
Monsomboon Apichaya, Nelson Bret P, Andrus Phillip, Tsung James W
机构信息
Division of Emergency Ultrasound, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Emergency Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
出版信息
Ultrasound J. 2019 Jun 11;11(1):12. doi: 10.1186/s13089-019-0128-5.
BACKGROUND
Stump appendicitis (SA) is a rare entity in patients with a history of appendectomy and may result in missed or delayed diagnosis. We report a case of SA diagnosed by emergency department (ED) point-of-care ultrasound (PoCUS) in an elderly woman, thus expediting her care.
CASE PRESENTATION
An elderly female patient with a history of appendectomy 27 years ago was referred by her physician to the ED with right lower quadrant pain for 2 days. Using PoCUS the emergency physician identified SA. This was confirmed by computed tomography (CT) scan. The patient was then successfully managed non-operatively using antibiotics.
CONCLUSIONS
Despite its rarity, it is feasible to diagnose SA using PoCUS, as patients presenting with right lower quadrant pain and history of appendectomy are at risk for delayed diagnosis, perforation, and poor outcome. PoCUS may reduce time to diagnosis, time to definitive operative or non-operative management, and minimize morbidity.
背景
残端阑尾炎（SA）在有阑尾切除病史的患者中是一种罕见疾病，可能导致漏诊或诊断延迟。我们报告一例老年女性患者，通过急诊科（ED）即时超声（PoCUS）诊断为SA，从而加快了对她的治疗。
病例介绍
一名27年前有阑尾切除病史的老年女性患者，因右下腹痛2天，由其医生转诊至急诊科。急诊医生通过PoCUS诊断出SA。计算机断层扫描（CT）证实了这一诊断。该患者随后通过抗生素治疗成功进行了非手术治疗。
结论
尽管SA罕见，但使用PoCUS诊断SA是可行的，因为出现右下腹痛且有阑尾切除病史的患者有诊断延迟、穿孔和不良预后的风险。PoCUS可以缩短诊断时间、明确手术或非手术治疗的时间，并将发病率降至最低。
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